Often, Tricare Prime patients consider switching to Tricare Standard when they find out that they are expecting a baby. A huge question is what kind of maternity coverage is provided by Tricare Standard - will switching cost a bundle? It's an important question, because maternity care in the United States is expensive. Some say it is the most expensive in the world. So, what will you pay if you use Tricare Standard?
As it turns out, not much at all.
Tricare Standard Maternity CoverageThe following information is accurate for active duty family members. Retirees have slightly higher costs, but still outstanding coverage.
Thanks to Tricare's "global" maternity coverage, Tricare Standard covers 100% of most maternity related care, just like Tricare Prime, without regard to the usual Tricare Standard deductible. This includes prenatal care, including labs, labor and delivery costs, the hospital stay, post-natal care, and the treatment of any pregnancy-related complications. You'll pay just $18 per day for the time you stay in the hospital, with a $25 minimum fee if you are only in the hospital for one day.
What Tricare Doesn't Cover?Tricare does not cover non-medically required ultrasounds, including ultrasounds to determine gender, private rooms at facilities where there are shared rooms available, umbilical cord collection and storage, and non-medical support during labor and childbirth, such as a doula.
Should You Switch?There's no single answer to this question. Many women prefer to receive maternity care outside of the military treatment facility (MTF) system. While I can't predict what is right for you, almost all of my readers who have switched to Tricare Standard for maternity care are happy with their choice.
Thankfully, active duty family members have the option to switch from Tricare Prime to Tricare Standard at any time without penalty or cost. Better yet, you can select different choices for different family members - you don't all have to be on the same plan.
It is important to remember that you'll be switching to Standard for all your care, not just the maternity care. If you break your arm or develop a plantar wart, you will be subject to all the usual deductibles and co-pays or cost-shares. In addition, you may have a waiting period before you are eligible to return to Tricare Prime. Be sure that your family can afford these costs before deciding to switch.
As always, there are exceptions and certain limits. Check with your doctor, hospital or birthing center, and Tricare to verify that your costs will be covered.
Tricare's maternity coverage is amazing, and you'll have relatively few costs regardless of which plan you choose. This gives you the freedom to choose the care that you want without worrying about huge costs. Thank you, Tricare.